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Albumin and surgical site infection risk in orthopaedics: a meta-analysis
Peizhi Yuwen1, Wei Chen1, Hongzhi Lv1
1Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, People's Republic of China.
Backgroud:
Surigical site infection has been a challenge for surgeons for many years, the prevalence of serum albumin <3.5g/dL has been reported to be associated with increased orthopaedic complications. However, the prognostic implications and significance of serum albumin <3.5g/dL after orthopaedic surgeries remain ambiguity. In this study, we performed a meta-analysis to access the predictive value of serum albumin level on SSI.
Methods:
A basic data search was performed in PubMed and Web of Science, in addition, references were manually searched. All of the observational studies contained preoperative albumin, outcomes of SSI or valuable data that could be abstracted and analysed for meta-analysis in orthopaedics. All of the studies were assessed using the classic Newcastle Ottawa Scale (NOS). They conformed to critical quality evaluation standards, and the final data analysis was performed with RevMan 5.2 software.
Results:
A total of 112,183 patients included in 13 studies were involved. The pooled MD of albumin between the infection group and the non-infection group was MD = -2.28 (95 % CI -3.97-0.58), which was statistically significant (z = 2.63, P = 0.008). The pooled RR of infection when comparing albumin <3.5 with albumin >3.5 was 2.39 (95 % CI 1.57 3.64), which was statistically significant (z = 4.06, P < 0.0001). Heterogeneity were found in the pooled MD of albumin and in the pooled RR for infection (P = 0.05, I2 = 61 % and P = 0.003, I2 = 68 %). No publication bias occurred based on two basically symmetrical funnel plots.
Conclusion:
Our meta-analysis demonstrated that an albumin level <3.5 g/dL had an almost 2.5 fold increased risk of SSI in orthopaedics, although this conclusion requires well-designed prospective cohort studies to be confirmed further.
Insights
Low serum albumin levels (<3.5 g/dL) in patients undergoing orthopaedic surgery significantly increase the risk of surgical site infection (SSI). This meta-analysis confirms that preoperative albumin is a key predictor of SSI, highlighting its importance in patient care.
Area of Science:
- Orthopaedic Surgery
- Infectious Disease Epidemiology
- Biochemistry
Background:
- Surgical site infection (SSI) is a significant complication in orthopaedic surgery.
- Low serum albumin levels (<3.5 g/dL) are associated with increased orthopaedic complications, but their predictive value for SSI is unclear.
Purpose of the Study:
- To perform a meta-analysis assessing the predictive value of preoperative serum albumin levels for SSI in orthopaedic patients.
- To determine the association between low serum albumin and the risk of developing SSI after orthopaedic procedures.
Main Methods:
- A systematic literature search was conducted on PubMed and Web of Science, supplemented by manual reference searches.
- Included observational studies with data on preoperative albumin and SSI outcomes in orthopaedic surgery.
- Studies were quality-assessed using the Newcastle Ottawa Scale (NOS); data analysis performed using RevMan 5.2 software.
Main Results:
- The meta-analysis included 13 studies with 112,183 patients.
- A statistically significant lower pooled mean difference (MD) of albumin was observed between infection and non-infection groups (MD = -2.28).
- Patients with albumin <3.5 g/dL had a 2.39-fold increased risk of SSI compared to those with albumin >3.5 g/dL (RR = 2.39, P < 0.0001).
Conclusions:
- Preoperative serum albumin level <3.5 g/dL is a significant independent risk factor for SSI in orthopaedic surgery.
- An albumin level below 3.5 g/dL is associated with an approximately 2.5-fold increased risk of SSI.
- Further well-designed prospective cohort studies are recommended to confirm these findings.
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